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DANE COUNTY ZONING PERMIT ZONING PERMIT NO Page 1 of 2 <br /> DCPZP-2014-00914 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> JAMES SMITH (608)235-8210 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6457 WOODLAND TRL <br /> (City,State,Zip) (City,State,Zip) <br /> DANE,WI 53529 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ssmith6457 @tds.net <br /> PARCEL.NO. TOWNSHIP SECTION 1/4 1/41/4 <br /> 0907-364-8300-0 TOWN OF ROXBURY 36 SE NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address Is 6457 WOODLAND TRL <br /> subject to field verification.) <br /> LOT IBLOCK C.S.M.NO.or PLAT NAME <br /> 1 I CSM 01098 <br /> ZONING DISTRICT PAAAtRRtCEL ACREAGE PROPOSED PROJECT: Alteration to existing building CENSUS CODE <br /> R-2 Residence Description:alteration(interior)to an existing sfr 434-Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> ❑ Other. Private <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road 2862 <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> Sq.Ft. Sq.Ft.324 324 <br /> PROJECT COST <br /> NO.OF STORIES 2nd FLOOR 3rd FLOOR $3,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $74.30 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of this permit renders this zoning permit null and void and subject <br /> to enforcement action. <br /> I acknowledge that I am responsible for complying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult <br /> to identify. Failure to comply may result in removal or modification of construction that violates the law or <br /> other penalties or costs. For more information, visit the Department of Natural Resources web page at <br /> www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitted premises by Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNATURE: Owner ,ent 1 DATE: <br /> Ordinances.Any unauthorized change from the information or / <br /> plans submitted will Invalidate the permit. 1111/$1)1 '14.1 121 I' <br /> OFFICE USE ONLY (form iorsion 03.00.07) <br /> SURVEY REQUIRED T DATE ISSUED INITIALS 1st INSPECTION DATE INITIALS <br /> 12/15/2014 SCW1 <br /> ❑ YES ® NO <br /> DATE REVIEWED \\\ INITIALS 2nd INSPECTION DATE INITIALS <br /> 5\ 1'S c <br /> ` i vt <br /> v <br />